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One of the most common phrases I hear amongst patients and in the media is “I’m eating for two,” when referring to pregnancy as an excuse for excessive food portions. This is just not true ladies. As I tell my patients, you are not, in fact, eating for two, but you are eating for yourself and a tiny baby. So that sandwich you are eating as an appetizer to your actual dinner? Completely unnecessary. I hate to break it to you ladies, but you only need about 200-300 extra calories A DAY. Unfortunately, excessive weight gain and/or obesity during pregnancy is a big deal. First, you run the risk of gestational diabetes, which turns your normal low-risk pregnancy into a high risk pregnancy, complete with food journals, blood sugar logs, and occasionally medications, frequent visits to the doctor, ect. We won’t even go into all that “fun stuff” in this post. Additionally, even without diabetes, we worry about the baby also gaining too much weight. This can lead to difficult, prolonged labors, complications during the delivery, and God forbid if you do need a c-section, don’t hold it against your doctor if she can’t make a very aesthetically pleasing incision/scar due to the inches of excessive fat tissue. In these situations, wound healing is at risk for dehiscence (opening of the incision), and risk of infection when the belly hangs low over the wound and creates a breeding ground for bacteria. Aside from the serious risks associated with excessive weight gain in pregnancy, your doctors also have to listen to your complaints about feeling tired, bloated, swollen, aches, stretch marks, “feeling like a whale,” and the list goes on and on. Don’t get me wrong, many of these complaints are inevitable parts of pregnancy, but can also be prevented or lessened in severity by simply watching what you eat.

So how do we prevent these unfortunate circumstances? First off, starting at a healthy prepregnancy weight and BMI is crucial to your overall health and well-being, whether you are planning pregnancy or not. Let’s not kid ourselves, we all love fast food, pizza, beer, and everything that might make you look pregnant when you arn’t.I for one have had an intimate love/hate relationship with pizza, pasta, and McDonalds forever. Recently, we have decided to go our separate ways, and now we are just friends. Trust me, I know your pain over eating right, exercising, and maintaining a healthy weight. But seriously, its important. If you should find yourself trading that “food baby” belly for a real baby bump belly, a healthy lifestyle is not just crucial for you, but for the health of your baby also.

Every woman and pregnancy is different. That being said, some women may have a little more leeway in how much weight is appropriate during pregnancy. For example, a woman that is already starting out with a high BMI or is overweight has a much smaller window for weight gain than another woman who is underweight. Its not that we are picking on the heavy girls, I promise, we all know you just have more to love. But you are already starting out at a riskier weight, and therefore the weight that you do gain, should more or less only be attributed directly to the pregnancy (growing baby, placenta, uterus, blood volume, etc.). So first off, determine your BMI (we all know you’ve seen that app in your phone), and based on your BMI, look at the chart to determine the recommended weight gain for the total pregnancy. Let me reiterate, this is how much weight you should be gaining by the END of your pregnancy, and the majority of that said weight should be happening towards the third trimester. If you find you have almost reached your total weight gain amount halfway through your second trimester, its time for an intervention. It’s not that we’re calling you out on your weight problems. OK maybe we are, but its because we care about you! There are times when excessive weight gain might have pathologic causes, and you might need some lab work and a little more investigation to figure out what’s going on. But if it’s because your pregnancy cravings sent you to Olive Garden for bottomless pasta bowls, then we have a problem. But please, I ask that no woman takes offense if that touchy weight gain subject comes up at one of your prenatal appointments. I promise, there is no pregnant woman mold, and we know how everyone has their own shape and size. But it is important to not be careless with eating and overeating during pregnancy. Please, stay away from fatty foods, and foods high in sugar and salts. Go for high fiber foods, veggies, whole grains, proteins, etc. We want a controlled, healthy weight gain that can keep your baby safe, and hopefully help make the pregnancy as enjoyable as possible.

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It is a common concern that is brought to me from both friends and patients alike—shaving for your GYN appointment. Do you shave it all off for better viewing, landscape to show you made the effort, or just let it all hang loose like the primal woman God made you?

From a profession opinion, it truly does not really make a difference to us. We have seen it all. Straight, curly, long, short, bald, afro, in all different trims and styles; pubic hair is as unique as the individual that grows them. If you are the kind of gal that likes mow her lawn on the regular, great. But if you are stressed about getting horrid razor burn, (or you just forgot) then don’t sweat it. Be comfortable with however you wear your downstairs carpeting. We are not here to judge– but if you pimp your pubes, your vajazzled vajayjay will undoubtedly be hilariously scrutinized. Kidding.

My one recommendation is for those that have long, unruly hair (you know who you are), it is better to have somewhat of a trim, at least around the area of interest, specifically, the labia majora (sides and lips). I say this simply because with better visibility, we are better able to asess and identify problems that might otherwise go unnoticed (condyloma, hpv warts, skin growths etc.). Not that getting a pelvic exam is ever a walk through the park, but it might be more tolerable to not get your strands caught in the machinery. That being said trimming especially before labor and delivery, there is less likelihood of getting rebellious hairs getting caught and pulled if you need stitches after..

Nonetheless, everyone has their own preferences to how they choose to decorate their bush. Embrace it. Or erase it. We don’t care. As your doctors, we are just glad you came in for your dreaded annual exam, so don’t let pubic hair taboos keep you away. Just keep it simple and keep it safe.

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I know it has been a while since my last post, and since I have now been over a month working at my new job as a Nurse Midwife, I figure it is well past time to update my devoted blog readers on my life these past couple months.

To start with, I think I have gathered a new philosophy for life. Avoid doing hair and make up before work for at least the first couple weeks when starting a new job. People will get used to you looking good and put together. Then when you happen to take a shower at work and don’t redo your hair and make up, people ask if you are feeling alright. And since lately I feel my day is generally filled with scrubbing in to assist on C-sections every day, I really question why I bother doing my hair at all before work, since I usually spend the entire day wearing my scrub cap.

A surprising aspect of my new job that I have found being in my new job is that my tolerance to submit to possibly unnecessary c-sections has become a lot lower. While still I’m a midwife very fond of promoting normal birth, I have started to find that so many of the women I care for are so high-risk for complications, that opting to side with doing a cesarean almost feels like the safer thing to do for this population. So many of my patients already that have seemed to be perfect candidates for normal birth seem to end up with difficult deliveries, dystocias, hemorrhages, strangely shaped placentas that won’t come out, and seriously their vaginas seem to basically explode pushing the baby, resulting so many large, painful lacerations requiring long and difficult repairs. While I have heard many times that this is a tough job to start with as a new midwife, I have found it keeps me up with my critical thinking and practical skills that may not be used very much in a very “normal birth” kind of setting. While I don’t particularly enjoy those teeth grinding, sweating bullets situations, it definitely keeps me more aware and up on my little midwife toes.

While I was a little traumatized by many of the birthing practices I saw in Argentina, I do frequently find myself thinking “what would the Argentineans do?” when I am in a grind. For example, one practice we learn here in the States that I really loathe doing is clamping and cutting a tight umbilical cord around the neck. I have had a couple experiences in training and at work where after cutting the cord around the neck after the head is born, it is only to find the shoulders to be tight and difficult to deliver. Cutting the cord before the baby is born leaves the baby without a life line that is crucial during a tight shoulder scenario. These babies usually need more help than usual getting started breathing and reacting after birth, and it is terrifying. What I found in Argentina is that they rarely even check for a cord around the neck after the baby is born, and even when there is one, there is no worry, because there is never any unlooping or cutting the cord before the body is born. Rather, they deliver every baby by what is referred to as the “somersault maneuver.” This technique is accomplished by simply tilting the baby’s face downward to the mother’s thigh after the head is out, then the rest of the body is then delivered in something like a flip, or somersault fashion, keeping the neck (and cord) close to the vagina to prevent pulling. When I first had this explained to me, and even after seeing it and being taught to do it hands on, I never ever thought I would have the coordination to pull this stunt off. Not when I’m in the middle of a delivery and nervous enough as it is! Strangely enough, the first few vaginal births I had after coming back from Argentina, I found my hands automatically flipping the baby out every time without trying; it just seemed like the natural thing to do, especially with a cord around the neck.

Another interesting fact is that I rarely have patients that speak English. And translators are not always readily available. While I am able to speak easily to my Spanish speaking patients, trying to communicate in Creole is a challenge I am not yet ready to face. I spent a day or so seriously studying the language, trying to memorize words and phrases, feeling ready to start learning Creole as my third language. “No gen pwoblem” right? Yeah, the next day I forgot everything, but felt a little more in touch with the broken French and clicking that I feel I will never able to reproduce.

Nonetheless, I am getting by. After a full 60-hour work week, I feel I can do [almost] anything. I can say I continue learning new thing every single day, and while I do miss my job as a nurse at times, I am glad to be in the profession I have come so far to do. I say my prayers daily, before and after work, and often during the day, because I know that “You Lord give perfect peace to those who keep their purpose firm and put their trust in You.” It was a verse that I kept with me all through midwifery school, and I will continue to live by it now as a professional.

If you have ever watched the show “Call the Midwife,” you will notice in the very beginning of the show, where the opening credits start, there is a visual of someone’s diary, and it says “Chapter 1: Why did I start this?” I highly recommend watching that show, its British but its phenomenal. And if you do watch Call the Midwife, this is an EXCELLENT parody to the show and a couple other, and it is absolutely hysterical. I know my fellow midwives will enjoy this one…

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Recently, I had the bittersweet experience in learning that my favorite teacher in high school was retiring. While I am very happy that Mrs. McIntosh is finally getting the opportunity to “stop and smell the roses,” I am sad to know students in the future will not have the chance to get the Mac experience. Much to the dismay of my other teachers that might come across this blog, I must admit that I feel I never truly studied for a class before taking Anatomy my Senior year of High School. I made it through Honors Biology, Honors Chemistry, Marine Biology, and floated through trying to get by. Sure I would do my homework assignments most of the time, and try to retain what I would pick up in class, but all that seemed mostly just to pass the tests (which in retrospect, I am quite surprised I ever made it through Honors classes with a decent GPA!). After hearing all the rumors about the rigorous curriculum given by “the Mac” as she was so frequently known as, I was definitely intimidated to be taking an advanced course where I might have to actually apply myself in my Senior year. Nonetheless, after the first few weeks, I felt myself thriving in the material she taught, trying to soak up every lesson, every chapter, I was absolutely fascinated my the human body. I always have had an interest in the body, and ever since I can remember I always thought I wanted to be a doctor or some sort, reading children’s anatomy book and what have you. But this was a whole new experience of profound interest in what I was learning, I found I actually ENJOYED studying! Whoever heard of such a thing?! When we were required to start watching House (when the show first got started and it was really good), I found an even greater devotion to this science as I learned not only how the body looked, but how it worked, how it was affected by everything. I was blown away and loved it all. When we were starting to study for the upcoming lab practical, I found myself frustrated how Mrs Mac would make us draw detailed sketches of every organ and body system; every single line and prominence of every bone, vessels, muscles etc. Never did I realize how much I would learn from her method of making us draw out these detailed body parts, but when I took Anatomy and Physiology later in University, I used this same method, and came out setting the grade curve on every test, and a final grade of 99% in the class. I knew Mrs Mac’s class was special to me when at the end of the year, as an otherwise unmotivated student with Senioritis, I was skipping classes not to go out the beach with my friends, but rather to go to Ms Mac’s class and continue dissecting my fetal pig, bare hands and all. I couldn’t get enough. And while I always figured I would probably try to go to college to do something in the medical field, I feel Ms Mac really pushed and motivated me to get into the nursing profession. I was always so excited to come back years later to fill her in on how nursing school was going, and I hope understands how significant a role she made in my career choice. And now, as a Certified Nurse Midwife and Nurse Practitioner, I can tell her that taking her class was one of the best choices I made in high school, and I don’t think I would have made it to where I am today without having the foundation for learning that I finally found in the “Mac Experience.”

Ms Mac, I congratulate you on your retirement, and wish you the best of luck with everything.

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Finishing my final weeks in Mendoza has undoubtedly been the experience of a lifetime, both personally and professionally.

Not only did I get the opportunity to meet and work with an incredible group of people throughout the placement, but I also had the opportunity to travel to Buenos Aires, meet some “familia,” and learn a little bit more what it means to be Argentinean.

As I mentioned in Parte 1 of my trip, things are very different in Mendoza, everything from the slow, easy pace of life to the routine practice of episiotomies on primagravidas. And what an odd balance of conservative and liberal interventions there are! One day, while sitting around with other parteras drinking maté, we came to the discussion of prenatal care and genetic screening. Interestingly enough, they don’t typically do any of our routine blood work for genetic screening, but on the other hand, will do 3 ultrasounds instead, at least one ultrasound each semester, starting around 12 weeks. It is in this way that they screen for physical abnormalities, fetal anatomy, and an estimated fetal weight at the end of the last trimester.

As a very ambitious homework assignment from my Spanish teacher, I took my official State Midwifery practice protocol and translated it into Spanish. Took a lot of time and effort on my part, but I definitely feel it helped to enable the other midwives to have a better understanding of the role and practices of the Nurse-Midwife (“la Enfermera-Partera”) in the United States.

Most things were more or less the same, and some very different. Parteras in Mendoza pretty much only work in the practice of birth. It was explained to me that very rarely are their midwives involved in prenatal or postpartum care, and almost never involved in non-obstetric gynecologic care.They are also unable to prescribe medications outside of Oxytocin or cervical relaxants during labor, not even antibiotics. They also do not First Assist or participate at all in cesarean deliveries. On the other hand, their midwives will often deliver twins and breech births, although, they did mention that breech births often are by cesarean delivery unless the woman has been laboring well prior to arrival at the hospital.

It still strikes me in amazement at the conservative approach they use with fetal monitoring however. Even for the “high risk” patients and patients on oxytocin, they only use the doppler to listen for fetal heart rate “every 30 minutes,” or whenever they finish another round of maté. Although I can’t blame them, sitting around in waiting is a practice that comes with the labor and delivery territory, feast or famine. But in the US, I feel like we always are at least trying to “seem” busy, whether it is watching the fetal monitors, comforting patients, doing CEU’s. In my hospital in Mendoza, there is no sense of really going above and beyond, and no one seems to mind either way. As if their practice of FHR monitoring didn’t shock me enough, the method they use for timing contractions is even stranger to me. Although they document contraction rate every 30 minutes with the fetal heart rate, it was explained to me that they count how many contractions there are in 10 minutes, measured by manual palpation. However, I have to say I don’t honestly think I ever saw anyone stand there for 10 minutes straight feeling for contractions. It was more, asking the mother how many she thinks she had in the last 10 minutes and going by that, although there are not actually any clocks in the room. Or taking a guess based on how often you can hear them call out from down the hall. It is also interesting the way they document everything. While each patient does have an official “chart,” (a pile of papers paper clipped together, in no particular organization), they will write their initial assessment (in more or less a similar format to our SOAP notes), and then all additional progress notes are written where ever seems like a good place, on no particular page in the chart. On my first day, I was really confused when trying to read the charts. Whereas in the United States we typically document cervical exams with brackets (for example: dilation/effacement/station), in Mendoza, they don’t seem to have much specific attention to effacement and station, but they use the same format not to document cervical exams, but on contraction monitoring. For example, # contractions in 10 minutes/length of contraction/intensity. Imagine trying to figure that out. It was very striking to me also, that keeping track of FHR decelerations and timing with contractions is much harder, because there is no tracings to review later. In this sense, one would imagine, especially since almost all the patients receive Oxytocin, that there would be a greater attention to a specific assessment of FHR in relation to timing and frequency of contractions. But no, not really of a whole lot of concern there. Interestingly enough, there were very few times I saw (or rather heard) fetal bradycardia. In those instances, there were no heroic interventions like putting on maternal oxygen, internal fetal monitoring, or even stopping the Oxytocin. Occasionally I saw they might tighten the clamp on the IV to slow the Oxytocin a bit, but the extent of interventions they generally take is just changing maternal position. Once the heart rate comes up after, the doctors seem pretty satisfied and don’t push the issue any further. And the most amazing part of it all, is that nearly all of these babies come out screaming, hardly ever needing resuscitative efforts, not even bulb suctioning. Go figure. While on the topic of resuscitation, you will recall in the first blog that I mentioned there are no baby warmers or resuscitative devices kept in the room. If the baby is having a slower time getting started crying, they simply poke their head out the door, shout “Neo!” down the hall, and just keep drying and stimulating till the Neo team arrives. It might be 10-15 seconds before anyone shows up, and usually the baby is already crying by then. But if the baby did need further resuscitation, the Neo team would grab the baby and run about 30-50 feet down the hall to the nursery. Incredible.

Another interesting concept is that there is no such thing as an “obstetric nurse” in Mendoza. All nurses have more or less only basic training, can give IV medication and start IV’s but none are allowed to do vaginal exams or push with patients, only midwives and doctors.

Also very interesting and rare sight to see in the US: a patient was pushing in the dilation room, and the baby was not descending as expected, despite her pushing efforts. I have seen very often in the US sitting the patient up in order to implement the natural force of gravity, and letting the patient “labor down.” Occasionally they would do this in Mendoza, but for this patient, when the FHR started slowing, instead of having the patient just sit up and rest rather than push, the midwives instead had her stand and squat to push. They then said they will know how she is progressing based on the amount of bloody show dripping on the floor. What?!

As a midwife, we are taught to embrace women in their experience of childbirth. However, labor coaching is not a common practice for the midwives of Mendoza. Rather than sitting with a patient and massaging or coaching her (as I felt a need to do), the other midwives/docs sit around in their on-call room drinking maté and chatting until someone started pushing or until it was time to check FHR again. To me, I felt torn between the desire to help and be with these women during their pain, while other part of me also felt a need to establish myself in discussions with the other providers and participate with them, whether be it checking cervixes or discussing the weather. It was a struggle to keep a balance between both obligations, because its so uncommon to be actively engaged in the patient’s labor outside of routine monitoring and pushing etc. Despite my best efforts to teach and show them labor coaching techniques, my teaching often seemed in vain. After only a few minutes, the midwives would stop and encourage me to go with them to talk instead.

In professional sense, the experience in Mendoza has left me with a combination of feelings: intrigued, terrified, enlightened, humbled, and thankful. When leaving for this trip, I had different plans about my participation as a Midwife in Mendoza, seeing it as being a sort of residency, an extention of my education of sorts. Boy was I in for a surprise. After all I saw from the first day onward, I certainly held myself with caution about what practices and routines I allowed myself to participate with. Taking everything with a grain of salt. Allowing myself to see and understand their practices, but not immerse myself enough to make habits or adopt them. Having a short and flexible schedule every day was helpful, knowing when things were becoming too overwhelming, and when I needed to take a step back.

I am beyond grateful for the experience, and recommend to anyone considering. Step out of the comfort zone, learn the unthinkable, appreciate what you do and what you have. From my time in Mendoza, I am taking back with me both the good and the bad, and ready to step into my new career with a new outlook for my profession.

For those they haven’t been in the loop, I have spent the last week and a half living and working in beautiful Mendoza, Argentina. I have been working with midwives here in a very busy public hospital, in a high risk obstetric unit. While I always knew from the beginning that things were going to be really different here, I had no idea the extent of how much I would be surprised by. Also, the language barrier caught me quite off guard on my first day. I have had pretty good knowledge of the Spanish language before coming here, being able to translate and speak with patients at work etc. I knew how to ask questions, take a

medical history, instruct someone through child birth, and give discharge education. But it never occured to me that it wouldn’t be the patients I would have difficulty talking to, but rather the staff. Being able to have normal everyday discussions became the biggest obstacle. Also, I never realized until being here how much of my knowledge of Spanish was quite dependent on “Spanglish,” and being able to throw in a word or two in English if I didn’t know how to say them. Here at the hospital NO ONE knows ANY English. Nada. So it was definitely a bit of a struggle my first couple days to be able to keep my mind in constant focus every minute to what’s being said, and training myself to stop translating in my head, but rather to simply think in Spanish. Fortunately, we have a really great Spanish teacher at the house who comes a couple hours twice a week to do lessons. I am happy to say I can finally speak outside of the present tense at last! This has definitely opened the field for conversation in the hospital, and I am becoming quite confident in my ability to talk with other people in the hospital about the differences between their practices and ours in the States, the things that quite literally blew my mind. For starters, when women come in labor, they are taken into a “dilation room,” which has about 6 or 7 “beds,” which are more like a table with a paperthin mattress, and they are required to basically lay there and suffer until they are complete. No epidurals, no pain medicine, no visitors with them, just sitting or laying on the beds sobbing and moaning for hours. There is absolutely no privacy, they do vaginal exams in front of everyone else, and the door of the room wide open, but no one seems to mind it nonetheless. What really surprised me however, is when they do get to completely dilated, the woman holds her bag of IV fluid and Pitocin, and walk down the hall to the delivery room, dripping amniotic fluid and bloody show on the floor like nothing.Then they go into the delivery room which is basically a metal table with stirrups (if they are lucky) otherwise there is just 2 metal poles they have to prop their feet against. No pillows, no adjustable bed, nada. Not even a baby warmer, no oxygen or resuscitation supplies, nothing.

And because I understand we in America are probably a bit overly aggressive about

continuous fetal monitoring, I was not surprised that they only listen for heart tones every 30 minutes. Even the patients on Pitocin.

But I was quite surprised that, even after the long walk down the hall with the baby basically crowing, they really don’t monitor the baby while she’s pushing, except when they were using forceps to deliver. And might I add no pain medication is given. The patients are draped with this “sterile” white cloth and instructed to push right away, the doors of the room wide open and everything. What really astonished me, one of the midwives told me that for primagravidas, it is routine to just go ahead and cut a mediolateral episiotomy before they start pushing. They do give some lidocaine first, but I couldn’t help but feel the pain of it for the patient.

As if that wasn’t enough torture for this sheltered little midwife, they have a tech or one of the other nurses or doctors stand or straddle the head of the bed, and apply fundal pressure. Knowing that just the mention of fundal pressure could cost you your license, I felt mortified at the site. After all is said and done, the patient and her baby are put on a stretcher to cuddle and bond in the hallway for a few hours until they are taken to the postpartum unit. After a first impression like that, it was hard to get the courage to go back. But the following day, it was a little better in the hospital, as there was a class of medical students there, and they invited me to join in their class for the day.I still mostly was just observing things, helping to get some heart tones and check a cervix here and there, but I felt more confident in communicating with the others, and the professor there was very helpful and very easy to understand. But after a few hours of paying super close attention to every word around you, it gets quite mentally exhausting. After a beautiful walk home in the Mendoza sunshine, it was time for Spanish class and “social activities” with the roommates.

The end of the first week definitely wrapped up on a good note. There are different midwives every day, and where as the midwives there on the other days were not unfriendly, they were not able to slow down and interact with me as much as the midwives there on Friday, which was a guy midwife and a woman midwife. After having seen the work flow from the previous days, I had a little bit better idea of how everything works, who is who, etc., and so there was less need for them to explain all that, and we were able to have really good conversations (in Spanish), drink Mate, and they were very facilitating to me, letting me check dilation and they even let me assist to deliver 3 babies today, which was really great.

This past week was a bit funky in terms of the work week, because Monday and Tuesday there were problems with the buses working, and the bus never showed up. So I spent the day being productive with my Spanish studies. Wednesday I went in, but it seemed like it was “C-section day.” When I arrived, there were about 7 patients all gowned and prepped for surgery. Possibly a day for the residents to practice their surgical skills I suppose. There were a couple midwife students from Mendoza there with me that day, so it was nice to be able to bond and work with them, as I still basically see myself in the student role. However, the same way I needed to do so many deliveries in order to graduate, they also do, and we did have one vaginal birth we did do. The patient came in contracting every 1-2 minutes, and before they even checked her in the dilation room, I could already see the head presenting. Thinking were just going to have a baby in the bed, I went ahead and grabbed my gloves, and to my surprise, they actually had her get up and walk down to the delivery room. By the time the patient was on the table the head was crowning, and the student still had not got her gloves on. I went ahead and kept my hands supporting the perineum, and basically told her to get her gloves on or I’m going to deliver this baby myself. Like any ambitious midwife student, she made the sacrifice of trying to get the other glove on, and delivered the rest of the baby with only one glove. Priceless. And, ironically, as much as I am not a fan of doing routine episiotomy for first pregnancy births, this was the first one that they didn’t cut (obviously there was no time), and go figure, she gets a third degree tear.

While a lot of the practices here have reason behind it, some of their habits will never fail to surprise me. Particularly, the common use of open toed sandals, flip flops, and even heels. One day, after a resident put a foley catheter in for a c-section patient, there weren’t any foley bags, so she just tied a glove around the end of the catheter and taped it instead. I also don’t ever think I will understand the “sterile technique” here either. A doctor might put on sterile gloves to do a cervical exam, and then dip her sterile gloved fingers into the jar of KY jelly they use for the fetal heart monitor. What?!

Nonetheless, I am having a really great experience out here. I am so much better able to appreciate not only the quality of the healthcare back home, but also the philosophy behind it, driven by empathy, compassion, and lawsuits. It is so strange to see these high risk women, no prenatal care, minimal fetal monitoring, and strangely aggressive birth interventions have babies that always come out screaming, with no need for oxygen, suction, or calculating Apgar scores. Yet back home, we practice with such strict protocol, doing everything by the book, and still seem to have more problems with babies needing some resuscitative efforts. It is both very humbling and enlightening to acknowledge such a concept. I feel like in comparing the conservative/aggressive nature of birth interventions here versus the US, I don’t really find that one medical culture necessarily has does or doesn’t do more than the other, but they almost sort of compliment each other like a Yin and Yang, by being more aggressive in some practices, and more conservative with others. And its not that they do these interventions just because thats what they were told, but they just take a position on the other side of the controversy than we do for that specific intervention. Between learning the language and learning their practices and philosophies, it has definitely been a very mind stimulating process thus far. And as such, makes a perfect welcome for a doing some wine tasting after work.